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General NPI Number Information
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NPI Number | 1952527202
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Entity Type | Organization
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Legal Business Name | LARCHMONT RADIOLOGY
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2010 WILSHIRE BLVD STE 408
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City | LOS ANGELES
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State | CA
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Zip | 90057-3598
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Country | US
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Telephone | 213-483-5953
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Fax | 213-484-2984
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Provider Business Mailing Address
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Address Line | 2010 WILSHIRE BLVD STE 408
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City | LOS ANGELES
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State | CA
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Zip | 90057-3598
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Country | US
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Telephone | 213-483-5953
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Fax | 213-484-2984
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Authorized Official
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Title or Position | CREDENTIALS
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Name | MISS SARA GONZALEZ
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Credential |
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Telephone | 213-483-5953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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